Lip Vermilion Research Articles

Effect of Sagittal Dentoskeletal Discrepancies on the Vermilion Height and Lip Area.

A frontal evaluation of the lips could provide important information during a routine clinical evaluation of facial aesthetics. There is a lack of ample evidence in the literature regarding variations in the vermilion height and lip area in various sagittal discrepancies when assessing facial aesthetics. The aim of this cross-sectional study was to evaluate and compare the vermilion height and lip area in dentoskeletal Class I, Class II, and Class III malocclusions. Subjects included female patients divided into four groups (Angle's Class I bimaxillary proclination [Class I BMP], Class II Division I [Class II Div 1], Class III and Class I normal [Class I N]) with 36 samples each. Standardized frontal facial photographs were taken at rest and during a posed smile. Thirty-five landmarks on the upper and lower lips were identified for measurements of the vermilion height and lip area. A one-way analysis of variance was used to identify overall differences, and the post-hoc Bonferroni test was applied for multiple comparisons. Class III showed a significantly smaller upper-lip area and significantly higher ratios of the upper-to-lower lip vermilion height/area. The ratios displayed an increasing trend from the midline to the corners of the mouth. Class I BMP and Class II Div 1 had significantly larger upper and lower-lip areas. Morphology of the lips is significantly correlated with underlying anteroposterior dentoskeletal discrepancies. During a clinical examination, a critical frontal evaluation of the lips is important as it is apparently indicative of the underlying sagittal discrepancy, especially in skeletal Class III malocclusions.

Superficial radiotherapy for non-melanoma skin cancer of the lip: a 44-year Italian experience

Background: Radiotherapy is a valuable therapeutic option for the treatment of non-melanoma skin cancer (NMSC) in the ageing population, in non-surgical candidates, or when the tumor is extensive or localized in a cosmetically sensitive area such as the lips.Objective: We report our 44-year experience in treating basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the vermilion lip using superficial radiotherapy.Methods: Forty-seven patients with biopsy-proven BCC or SCC of the lip were retrospectively reviewed. All patients had been treated with superficial radiotherapy in our unit, as a primary treatment or with adjuvant and salvage purposes. Lymph-node involvement at presentation was negative in all patients.Results: Local disease control was achieved in 91% of cases. Cure rates of 85% were obtained at 5 and 10 years. Four patients presented local tumor recurrence and only one patient developed lymphatic involvement. Cosmetic outcome was good in the majority of cases, and all patients, except for one, fully preserved the vermilion lip functionality.Conclusions: Our findings confirm that superficial radiotherapy is an effective treatment for early BCC or SCC of the vermilion lip, especially in the ageing population, in high-risk tumors, and even if poor cosmetic outcome is expected from surgical excision.

Age-related changes in the vasculature of the dermis of the upper lip vermilion.

Lip redness is unique to humans and creates an important facial impression, but this redness decreases with age. Here, using histological and immunohistological staining of human upper lip vermilion from donors of different ages, we investigated blood vessels in the upper lip dermis and age-dependent histological changes. We found that both total vessel area in the dermis and vessel number in the upper dermis decreased with aging. Moreover, vessel number in the upper dermis correlated positively with development of rete ridges, which flattened with age, despite no significant change in the thickness of the stratified squamous epithelium. These findings suggest that age-related reductions in lip redness result from a decrease of blood vessels, which in turn leads to a flattening of the epithelium caused by the loss of rete ridges. This is the first study to histologically demonstrate age-related reductions in blood vessels in the lip. Our results provide an opportunity for enhancing blood flow/vascularization to improve the aesthetic appearance of the lips in the elderly.

Effective method for reconstruction of remaining lower lip vermilion defect after a mental V-Y advancement flap.

BackgroundThe mental V-Y advancement flap method is useful for reconstruction of lower lip defect because of its many advantages. However, it is not easy to select the optimal reconstructive method for the vermilion defect that remains after application of the mental V-Y advancement flap. In choosing the representative surgical method for vermilion mucosal reconstruction including mucosal V-Y advancement flap, buccal mucosal flap, and buccal mucosal graft. We describe an efficient technique to large lower lip defects combining mental V-Y advancement flap and buccal mucosal graftMethodsThis study included 16 patients who underwent reconstructive surgery for full-thickness and large defect (> half the entire width) of the lower lip from October 2006 to September 2017. The operation was conducted using mental V-Y advancement flap with various vermilion mucosal reconstruction methods considering the location of the defect and the amount of residual tissue of the lip coloboma after excision.ResultsAll patients underwent mental V-Y advancement flap. In vermilion mucosal reconstruction, five patients underwent mucosal V-Y advancement flap, three underwent buccal mucosal flap, and eight underwent buccal mucosal graft. There were good aesthetic and functional results in all patients who underwent buccal mucosal graft. However, two patients who underwent mucosal V-Y advancement flap complained of oral incompetence, and all patients who underwent buccal mucosal flap had oral commissure deformity.ConclusionBuccal mucosal graft combined with mental V-Y advancement flap can produce suitable functional and aesthetic outcomes in near total lower lip reconstruction in patient with large mucosal defect including vermilion portion.

Premaxillary Injection for Perioral Rejuvenation and Lip Enhancement.

This is the first study to evaluate the effect of premaxillary filler injection on nasal tip projection, upper lip projection, and upper lip vermilion height. The primary objective of this study was to analyze the change in nasal tip projection (measured by the Goode ratio) and the change in upper lip projection (measured by the Z angle) following premaxillary hyaluronic acid injection. A secondary objective was to measure the change in upper lip vermilion height. We hypothesized that treated subjects will show an increase in nasal tip projection, upper lip projection, and upper lip vermilion height. Twenty volunteer patients with signs of perioral aging or poor upper lip projection were enrolled in this prospective cohort study and underwent premaxillary hyaluronic acid filler injection between November 2017 and June 2018. Nasal tip projection, upper lip projection, and upper lip vermilion height were assessed from baseline and posttreatment photographs based on the Goode ratio, Z angle, and lip vermilion height ratio, respectively. No significant change was noted between pre- and posttreatment Goode ratio measurements (P = 0.841). There was a significant decrease in Z angle and therefore significant increase in upper lip projection with treatment (P < 0.001). The lip vermilion height ratio demonstrated a trend of increased upper lip vermilion height but this did not achieve statistical significance (P = 0.561). Premaxillary filler treatment resulted in a significant increase in upper lip projection. Premaxillary filler injection when performed in a safe manner is a valuable treatment option for perioral rejuvenation.

Three-dimensional changes in lip vermilion morphology of adult female patients after extraction and non-extraction orthodontic treatment.

ObjectiveTo investigate the three-dimensional lip vermilion changes after extraction and non-extraction orthodontic treatment in female adult patients and explore the correlation between lip vermilion changes and incisor changes.MethodsForty-seven young female adult patients were enrolled in this study (skeletal Class III patients were excluded), including 34 lip-protruding patients treated by extraction of four first premolars (18 patients requiring mini-implants for maximum anchorage control and 16 patients without mini-implants) and 13 patients requiring non-extraction treatment. Nine angles, seven distances, and the surface area of the lip vermilion were measured by using pre- and post-treatment three-dimensional facial scans. Linear and angular measurements of incisors were performed on lateral cephalograms.ResultsThere were no significant changes in the vermilion measurements in the non-extraction group. The vermilion angle, vermilion height, central bow angle, height/width ratio, and vermilion surface area decreased significantly after the orthodontic treatment in the extraction groups, but the upper/lower vermilion proportion remained unchanged. Significant correlations were found between the changes in incisor position and those in vermilion angles, vermilion height, and surface area.ConclusionsExtraction of the four first premolars probably produced an aesthetic improvement in lip vermilion morphology. However, the upper/lower vermilion proportion remained unchanged. The variations in the vermilion were closely related to incisor changes, especially the upper incisor inclination changes.

Solitary keratoacanthoma of the lip vermilion: case report and comprehensive review of literature

Solitary keratoacanthoma of the lip vermilion: case report and comprehensive review of literature

Cosmetic and Functional Outcomes of Second Intention Healing for Mohs Defects of the Lips.

The lips are a common location for skin cancer and thus for Mohs micrographic surgery (MMS). There are few studies looking at second intention healing of Mohs defects of the lips, and none have used a scar assessment scale. To evaluate the acceptability of second intention healing of the vermilion lips following MMS using a patient questionnaire and the Patient and Observer Assessment Scale (POSAS). Eligible patients were found through chart review. A patient questionnaire and the patient scale of the POSAS were performed over the phone. For patients who were able to come to clinic, the observer scale of the POSAS was performed. Forty-seven phone interviews and 21 clinic assessments were performed. Overall, patients noted excellent functional outcomes, and good to excellent cosmetic outcomes, and were satisfied with healing time. There was not a significant difference between the patient and observer total scores (p = .63) or overall scores (p = .59). Second intention healing can have satisfactory functional and cosmetic outcomes and healing times with few complications and should be considered for surgical defects on the vermilion lips as large as 2.8 cm even when there is involvement of the cutaneous lip and muscular layer.

Expanding the Spectrum of BAF-Related Disorders: De Novo Variants in SMARCC2 Cause a Syndrome with Intellectual Disability and Developmental Delay

SMARCC2 (BAF170) is one of the invariable core subunits of the ATP-dependent chromatin remodeling BAF (BRG1-associated factor) complex and plays a crucial role in embryogenesis and corticogenesis. Pathogenic variants in genes encoding other components of the BAF complex have been associated with intellectual disability syndromes. Despite its significant biological role, variants in SMARCC2 have not been directly associated with human disease previously. Using whole-exome sequencing and a web-based gene-matching program, we identified 15 individuals with variable degrees of neurodevelopmental delay and growth retardation harboring one of 13 heterozygous variants in SMARCC2, most of them novel and proven de novo. The clinical presentation overlaps with intellectual disability syndromes associated with other BAF subunits, such as Coffin-Siris and Nicolaides-Baraitser syndromes and includes prominent speech impairment, hypotonia, feeding difficulties, behavioral abnormalities, and dysmorphic features such as hypertrichosis, thick eyebrows, thin upper lip vermilion, and upturned nose. Nine out of the fifteen individuals harbor variants in the highly conserved SMARCC2 DNA-interacting domains (SANT and SWIRM) and present with a more severe phenotype. Two of these individuals present cardiac abnormalities. Transcriptomic analysis of fibroblasts from affected individuals highlights a group of differentially expressed genes with possible roles in regulation of neuronal development and function, namely H19, SCRG1, RELN, and CACNB4. Our findings suggest a novel SMARCC2-related syndrome that overlaps with neurodevelopmental disorders associated with variants in BAF-complex subunits.

Lip Leishmaniasis with Oral-mucosal Involvement: A Case Report

Statement of the problem: Nowadays leishmaniasis is a common infectious disease around the world which is caused by a protozoan parasite named Leishmania. This parasite is transmitted to human by an infected female sand fly. This disease has three clinical forms; mucosal forms are rare in Iran. Purpose: The purpose of this study was to report a case of leishmaniasis with lip and oral mucosal involvement that healed successfully. Results: This article is about patients with lip leishmaniasis with oral-mucosal involvement, clinical features were diffuse lip swelling and ulcer in right lower lip vermilion and buccal mucosa. A smear was caught which proved the diagnosis of leishmaniasis. Thereafter, the patients were referred to a dermatologist for treatment and follow up showed complete healing of the lesions. Conclusion: Oral mucosal leishmaniasis is rare. However, the swelling may cause different complications like loss of teeth or respiratory obstruction. It should be noted that time is a key point in treatment. So, it is necessary for us to train the differential diagnosis of chronic ulcerated oral lesions to our dentists.

Characteristics of non‐melanoma skin cancers of the cutaneous perioral and vermilion lip treated by Mohs micrographic surgery

The lip and surrounding perioral region are susceptible to non-melanoma skin cancer, but the distribution of basal cell and squamous cell carcinoma on the cutaneous and vermilion lips has not been fully elucidated. To investigate the distribution of cutaneous and vermilion lip non-melanoma skin cancer and to better describe risk factors, anatomic location, treatment characteristics and oncologic outcomes. A retrospective comparative case series of patients undergoing Mohs micrographic surgery (MMS) at a single academic centre for lip and perioral basal cell and squamous cell carcinoma was performed over a 5-year period. Demographics, medical comorbidities, surgical characteristics and recurrence status were extracted. Forty-five vermilion and 116 cutaneous lip cancers were identified. Basal cell carcinoma (BCC) was more common in the cutaneous perioral region, while squamous cell carcinoma (SCC) was more common on the vermilion lip (P<0.001). BCCs were more common on the upper vermilion lip and SCCs were more common on the lower vermilion lip (P<0.001). Within the cutaneous perioral region, both BCCs and SCCs were more common on the upper perioral surface (P=0.002). Male gender was associated with lower lip SCC (P=0.015). Smoking, immunosuppression, anticoagulant use and hydrochlorothiazide use were not associated with cancer type or location. Recurrences were rare, but more common in vermilion lip cancers (6.6%) compared to perioral cutaneous cancers (0.8%). Outcomes for all groups were similar; BCCs of the vermilion lip had significantly greater mean MMS stages (P<0.001) as did SCCs (P=0.05). Basal cell carcinoma is more commonly encountered on the cutaneous lip, whereas SCC is more common on the vermilion lip. Within the vermilion lip, BCC favours the upper lip, while SCC favours the lower lip. Within the cutaneous perioral region, both BCC and SCC favour the upper cutaneous tissue. Early stage lip cancers are curable by Mohs micrographic surgery with rare recurrences.

LB1521 Association of nodal metastasis with vermilion lip location in cutaneous squamous cell carcinoma of the lip

LB1521 Association of nodal metastasis with vermilion lip location in cutaneous squamous cell carcinoma of the lip

Postoperative long-term results for the comparison of the symmetry of the upper lip during lip closure according to Millard and Pfeifer

BackgroundClefts in newborns are associated with severe morphological and functional impairment. Especially the lip is of importance as if the treatment result is unsatisfactory, it can lead to psychological changes in the patient. Different operative procedures have been developed over the last decades. The aim of the presented study was the comparison of the surgical techniques according to Millard and Pfeifer regarding the temporal development of the postoperative symmetry of the lip height and mouth width.MethodsDigitized photographs of patients from the department of oral and maxillofacial surgery at the University of Göttingen were evaluated from 1979 to 1996. With a video analysis program, the lip height and mouth width were analyzed regarding the symmetry. We demonstrated the symmetry values over a period of 8 years in order to show the influence of growth on postoperative results.ResultsThe development of the vertical symmetry of the Philtrum and the lip vermillion on the cleft side in comparison to the healthy side behaves differently depending on Pfeifer and Millard. The lip height of the cleft lip was shorter in both techniques than on the healthy side, but Pfeifer’s difference was significantly more pronounced. The lip vermillion height on the cleft side was slightly shorter in the Millard group and markedly larger in the Pfeifer group. Both techniques can achieve good symmetry results for the vertical dimension of the lip. According to Pfeifer, the development of the horizontal dimension on the cleft side is bigger within the first 4 years than on the healthy side; according to the Millard technique, the horizontal development is smaller. These differences are greater within the first 6 years and approach between the 6th and 8th year.ConclusionsThe Millard technique demonstrates better results concerning the philtrum and vermillion symmetry during growth within the first 6 years. Over the whole study period, growth corrects the philtrum and vermillion symmetry within the Pfeifer group.

Association of Nodal Metastasis and Mortality With Vermilion vs Cutaneous Lip Location in Cutaneous Squamous Cell Carcinoma of the Lip

Although the lip is considered a high-risk location in cutaneous squamous cell carcinoma (cSCC), it has not been established whether this risk stems from vermilion or cutaneous locations or both. To compare differences in risks of recurrence, metastasis, and death from cSCCs on the vermilion vs cutaneous lip. Retrospective cohort study of 303 patients with 310 primary cSCCs of the lip (138 cutaneous, 172 vermilion) diagnosed between 2000 and 2015 at 2 academic tertiary care centers in Boston, Massachusetts. Development of local recurrence, nodal metastasis, distant metastasis, disease-specific death, and all-cause death. Of the 303 study participants with 310 SCCs of the lip, 153 (50.5%) were men, and 150 (49.5%) were women; median age at diagnosis, 68 years (range, 27-93 years). Outcomes were as follows for vermilion vs cutaneous locations: local recurrence, 6.4% (11 of 172) vs 2.9% (4 of 138); nodal metastasis, 7.6% (13 of 172) vs 1.5% (2 of 138); distant metastasis, 0.6% (1 of 172) vs 0.7% (1 of 138); disease-specific death, 3.5% (6 of 172) vs 2.9% (4 of 138); and all-cause death, 26.7% (46 of 172) vs 29.0% (40 of 138). The difference was statistically significant for nodal metastasis (P = .01). In multivariable analysis, nodal metastasis was associated with vermilion lip location (subhazard ratio, 5.0; 95% CI, 1.1-23.8) and invasion beyond fat (fascia or beyond for vermilion lip) (subhazard ratio, 4.4; 95% CI, 1.3-14.9). The risk of nodal metastasis is 5-fold greater for cSCCs on the vermilion lip compared with those on the cutaneous lip. Squamous cell carcinomas of the cutaneous lip have a nodal metastasis risk similar to cSCCs in general (1.5%). Thus, vermilion involvement appears responsible for the increased risk associated with cSCC of lip. Vermilion involvement may merit radiologic nodal staging and inclusion in future tumor staging, since it was independently associated with higher-risk cSCC of the lip region.

Microanatomical Location of Hyaluronic Acid Gel Following Injection of the Upper Lip Vermillion Border: Comparison of Needle and Microcannula Injection Technique.

To compare needle and microcannula injection techniques in regards to the microanatomical location of hyaluronic acid (HA) gel injected in the upper lip vermillion border of cadaver specimens. The upper lip vermillion border was injected transcutaneously with HA gel in 8 fresh hemifaces of 4 female human cadavers. Each hemiface was injected by a single experienced injector, the right side using a 27-gauge microcannula and the left side using a 30-gauge needle. A 2-cm region of each lip was excised lateral to a point 1-cm lateral to the philtrum. Specimens were fixed in 95% alcohol, embedded in paraffin, and stained with hematoxylin-eosin for histologic examination. Most HA injected with either a needle or a microcannula was located within the orbicularis oris muscle, and the remaining HA resided within the subcutaneous fat. In 3/4 right (microcannula) hemifaces, 100% of the HA was located within the muscle. Only 2/4 left (needle) hemifaces had at least 95% of the HA located within the muscle. Overall, in right (microcannula) hemifaces, 93% of the filler was located within the muscle, and in left (needle) hemifaces, 79% of the filler was located within the muscle (p =0.14). Most HA filler injected into the vermillion border after either microcannula or needle injection resides within the orbicularis oris muscle rather than in a subcutaneous/submucosal location. Injection with a microcannula shows a trend for more uniform intramuscular location compared with needle injection.

Facial and Nasolabial Aesthetics of Complete UCLP Submitted to 2-Stage Palate Repair With Vomer Flap.

To evaluate the aesthetics of nasolabial appearance and facial profile of children with unilateral cleft lip and palate (UCLP) submitted to 2-stage palate repair with vomerine flap. Retrospective. Single center. Forty patients with UCLP, mean age of 7.81 years of both sexes, rehabilitated at a single center by 1 plastic surgeon. Lip and anterior palate repair with nasal alar repositioning was performed at 3 to 6 months of age by Millard technique and vomer flap, respectively. Posterior palate was repaired at 18 months by Von Langenbeck technique. Four cropped digital facial photographs of each patient were evaluated by 3 orthodontists to score the nasolabial aesthetics and profile. Frequencies of each score as well means and medians were calculated. Kappa test was used for evaluating inter- and intrarater reproducibility. The nasal form and deviation was scored as good/very good in 70%, fair in 22.5%, and poor in 7.5% of the sample. The nasal-subnasal aesthetic was considered good/very good in 55%, fair in 30%, and poor in 15% of the sample. The lip vermilion border and the white part of surgical scar aesthetics were good/very good in 77.5% and 80%, fair in 17.5% for both categories, and poor in 5% and 2.5% of the cases, respectively. In all, 67.5% showed convex facial profile, 20% was straight, and 12.5% was concave profile. Two-stage palatoplasty presented an adequate aesthetical results for the majority of patients with UCLP in the mixed dentition.

Modified Abbé flap for reconstruction of Cupid's bow and vermilion tubercle in secondary cleft lip deformity.

Background Abbé flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional Abbé flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid’s bow and central vermilion tubercle with minimal sequalae.Methods From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid’s bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation.Results Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid’s bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional Abbé flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile.ConclusionA new modified Abbé flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid’s bow.

Correction of vermilion lip retraction after mucosal advancement flap: A countertraction technique

Correction of vermilion lip retraction after mucosal advancement flap: A countertraction technique

Heterozygous mutations affecting the protein kinase domain of CDK13 cause a syndromic form of developmental delay and intellectual disability

IntroductionRecent evidence has emerged linking mutations in CDK13 to syndromic congenital heart disease. We present here genetic and phenotypic data pertaining to 16 individuals with CDK13 mutations.MethodsPatients were investigated by...

Improving the Results of Cross Lip Vermilion Flap in Cleft Patients.

Cross lip vermilion flap is a myomucosal flap that uses lower red lip to augment deficient upper lip vermilion. Technical note that helps in imitating upper lip tubercle structure is presented. Appropriate patient selection to prevent unfavorable results such as color mismatch, local vermilion excess, and lower lip thinning are presented. Indirect benefits of this flap for decreasing upper incisor tooth show and better balance of upper/lower lip thickness are discussed.